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A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy
Authors:Hilfiker-Kleiner Denise  Kaminski Karol  Podewski Edith  Bonda Tomasz  Schaefer Arnd  Sliwa Karen  Forster Olaf  Quint Anja  Landmesser Ulf  Doerries Carola  Luchtefeld Maren  Poli Valeria  Schneider Michael D  Balligand Jean-Luc  Desjardins Fanny  Ansari Aftab  Struman Ingrid  Nguyen Ngoc Q N  Zschemisch Nils H  Klein Gunnar  Heusch Gerd  Schulz Rainer  Hilfiker Andres  Drexler Helmut
Affiliation:Department of Cardiology and Angiology, MHH, 30625 Hannover, Germany. hilfiker.denise@mh-hannover.de
Abstract:Postpartum cardiomyopathy (PPCM) is a disease of unknown etiology and exposes women to high risk of mortality after delivery. Here, we show that female mice with a cardiomyocyte-specific deletion of stat3 develop PPCM. In these mice, cardiac cathepsin D (CD) expression and activity is enhanced and associated with the generation of a cleaved antiangiogenic and proapoptotic 16 kDa form of the nursing hormone prolactin. Treatment with bromocriptine, an inhibitor of prolactin secretion, prevents the development of PPCM, whereas forced myocardial generation of 16 kDa prolactin impairs the cardiac capillary network and function, thereby recapitulating the cardiac phenotype of PPCM. Myocardial STAT3 protein levels are reduced and serum levels of activated CD and 16 kDa prolactin are elevated in PPCM patients. Thus, a biologically active derivative of the pregnancy hormone prolactin mediates PPCM, implying that inhibition of prolactin release may represent a novel therapeutic strategy for PPCM.
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